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· MEDecision Unveils Care Management Solution
· Serial RAID Storage Scales to Data Center Capacities
· Centralized PACS Links Large HealthCare System
· CAD Solution Experiences Rebirth
· Holding out for All-in-one Solution Works Wonders for Teleradiology Services Firm
MEDecision Unveils Care Management Solution
The pressure is building for health plans to better align information technology resources with business and health care requirements, according to collaborative health care management firm MEDecision Inc, Wayne, Pa.
To temper this growing burden, the company has introduced a next-generation care, disease, and utilization management solution called the Alineo platform. It is a rearchitected solution that aims to foster improvement in quality, safety, and affordability of care.
“Alineo facilitates these efforts through an innovative, member-centric approach,” said David St Clair, MEDecision founder and CEO. “It enables health plans to improve the quality and affordability of care by helping them optimally manage risk and compliance, increase efficiencies, enhance business agility, and control costs.”
The health care management platform provides a simplified and smart process for analyzing, applying, and automating payor-driven best practices. More specifically, it features an entirely new user interface with an intuitive screen design to offer a simplified user experience, which streamlines workflow, user efficiency, and overall productivity. Also, it is equipped with predictive modeling tools that identify patients who can benefit the most from case and disease management programs. With its embedded clinical content, the solution delivers turnkey clinical knowledge and programs for creating patient care plans, while encouraging clinical consistency.
Other benefits include the ability to automatically and intelligently administer and evaluate individual member and population-wide care programs, such as approvals, referrals, and extensions. The open, standards-based technology has extensible architecture that comes with the flexibility needed for ever-changing organizational needs and technical requirements.
St Clair said during the development process, the company sought to make full use of state-of-the-art technology advances. “The new platform will allow health plans to easily integrate new and existing applications from internal organizations and external vendors, giving them the capacity to grow and change their information technology as the organizations themselves grow and change,” he said. “We believe it is exactly what organizations need to function at the highest level while helping to ensure the best possible care.”
Other components included in Alineo offer functionality in reporting, correspondence, automated approvals, clinical intelligence, and clinical summaries. Additional components, such as clinical criteria, clinical programs, and care management analytics, will be integrated with MEDecision’s ongoing product development.
Serial RAID Storage Scales to Data Center Capacities
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| With a focus on scalability, reliability, and performance, Promise Technology recently added to its VTrak E-Class Family of SAS RAID solutions. |
Anyone who has ever operated a computer has likely experienced it. Each day, the system runs slower and slower, until at some point, it seems to struggle even more so than usual. And then, crash.
“An industry has grown up around the notion that hard drives tend to fail,” explained Michael Joyce, senior director of marketing at Promise Technology Inc, based in Milpitas, Calif. “They’re basically the last moving part in a computer. So because they tend to fail, there was a need to come up with a way to have one hard drive and back it up with another hard drive, to develop redundancy.”
Addressing customers’ demands for new standards in RAID subsystem scalability, reliability, and performance, Promise Technology has added to its VTrak E-Class Family of SAS RAID solutions. The VTE610fD and the VTE610sD subsystems, along with the VTJ610sD companion expansion chassis, are equipped with Fibre Channel or SAS host interfaces and SAS or SATA drive support that offer mission-critical reliability through redundant No-Single-Point-of-Failure (NSPOF) design.
“Files are stored as quickly as possible, and likewise they are retrieved as quickly as possible,” Joyce said. “It gives you the best performance in your subsystem. Radiologists aren’t waiting around for images to load.”
The core piece of equipment is a storage box that includes 16 SAS/SATA Drive Bays and two independent RAID controllers that allow for fast file transfer. “For folks who are doing imaging applications, the ability to support these technologies is very useful,” Joyce said. “The SATA drives tend to be very good at transferring, storing, and playing back very large image files, like CT scans. The SCSI drives are good for transferring large numbers of smaller amounts of data, such as patient records.”
Furthermore, four expansion cabinets can be configured behind a single RAID subsystem, allowing Promise Technology to deliver 166K IOPS; capacities up to 80TB; and dual active, failover/failback reliability in a single rack. This latter feature involves having one controller take over if a cable from the other controller gets kicked out or fails for any reason. “Even if there’s a disruption in the data path, your operation continues to work and continues to be useful,” Joyce said. “Your resources continue to be productive. In addition, you do not lose access to your images, to your patient data.”
Customers also specifically requested that the solution allow for scalability. This can be accomplished through the four expansion chassis, Joyce explained. Small facilities can start by purchasing just the RAID box, and later as business grows, they can take on an additional expansion box.
Other key features of the technology include the ability to support up to 2G of battery-backed cache; redundant, hot-swappable power supplies and cooling modules; a comprehensive embedded WebPAM PROe management suite; PerfectRAID and Predictive Data Migration technology for robust error handling and recovery; free 24/7 telephone technical support; and a 3-year warranty and advanced replacement program.
This latest offering joins a family of products that exceeds the performance and bandwidth requirements of even the most data-intensive applications, according to Promise Technology. All system components are constantly monitored using industry standard protocols. Furthermore, RAID 6 manages double-drive failures, increasing protection against data loss.
Centralized PACS Links Large HealthCare System
With its 21 separate radiology, cardiology and pathology imaging systems, each with a dedicated storage solution, Mercy Health Partners realized 3 years ago that if the volume and size of imaging exams were to continue its rapid growth, it needed a centralized storage architecture to support current and future needs.
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| Terrance Lewis, MD, reviews a CT angiogram using an integrated CARESTREAM RIS/PACS workstation at Mercy Health Partners. |
“These departments and their clinical users rely upon our IT staff to maintain fast, reliable access to imaging studies, along with disaster recovery,” according to an internal memo authored by Chief Information Officer Jim Albin and Director of Technical Services Bill Borer. “We didn’t need a crystal ball to see that maintaining these disparate systems would rapidly outpace our personnel and financial resources.”
Market research ultimately led the Toledo, Ohio-based health care provider to Carestream Health Inc, whose storage management software supported both DICOM and non-DICOM information archived across multiple locations and platforms. Since its first installation at MHP’s primary local data center at St Vincent Mercy Medical Center, Carestream has helped in establishing centralized management of PACS and cardiology studies at its four largest hospitals, in addition to integrating studies from three remote hospitals.
Recently, MHP upgraded to the latest KODAK CARESTREAM PACS platform, which promotes staff efficiency and productivity. Awaiting installation at the seven hospitals, the newest platform incorporates an enhanced Web-based functionality and dynamic streaming technology for faster delivery of imaging studies. The software, which comes with advanced features like 3D and orthopedic templating, will also be implemented at MHP’s new heart and vascular center in Toledo. A new licensing plan allows MHP to purchase user-based licenses that can be used from any location, and specialized display protocols organize images into the radiologist’s preferred format.
“Our clinicians have seen major improvements in functionality and convenience with this PACS platform,” said Leslie M. Beidleman, PACS administrator at MHP. “The user interface is the same, regardless of whether a physician is at a hospital workstation or a remote home or office PC, and that greatly enhances productivity.”
In addition to its large medical centers, MHP’s remote hospitals have been positively affected from the installation. Network connections were upgraded to 15 and 20 megabytes per second, providing acceptable response times for the three facilities. Radiologists who work from these rural hospitals can seek consultations with specialists immediately, while simultaneously reviewing the studies.
“This PACS adeptly accommodates a distributed environment like ours,” Beidleman said. “We are creating a regional PACS that will serve remote hospitals and allow authorized physicians to view patient information and images captured at any of these hospitals from their homes and offices.” Rural hospitals, Beidleman added, will utilize a server for on-site storage of about 12 to 24 months of exams. Imaging studies will also be stored at the central server to provide system-wide access to images and disaster recovery, she continued.
Of course, MHP evaluated the financial aspect that came with such a comprehensive solution. Ultimately, it decided the systems’ upsides greatly outweighed any costs. “While we did look at the financial investment required by this implementation, our driving force was the cost we would face if we did not undertake it,” stated Albin and Borer in a written memo. “Maintaining dozens of separate imaging and information management systems would place an untenable financial burden on our institution in the coming years.”
And most importantly, the system allowed for patients to reap the greatest benefits. Emergency department physicians and surgeons can view patient images from other facilities before the patient arrives at the hospital, which allows staff to prepare the necessary equipment, personnel, and treatment plan. Beidleman also noted that the PACS enhances resident training, allowing resident physicians to confer with remote radiologists or specialists. As a result, it will yield a more knowledgeable and educated next generation of physicians.
CAD Solution Experiences Rebirth
Medipattern’s B-CAD solution, a diagnostic tool intended for use by breast radiologists reading sonography, received FDA certification 2 years ago. However, under a new Cedara Clinical Control Center (C4) from Cedara Software, new life will be breathed into the product, the first and only FDA-certified CAD product for breast ultrasound imaging.
“B-CAD increases consistency in reading breast ultrasound imaging and increases productivity,” said Janet Sterritt, vice president of sales and marketing at Medipattern. “Offering it through the C4 environment makes it available to PACS vendors as an easily integrated solution for reading with CAD in a softcopy environment.”
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| Medipattern’s B-CAD solution segments the edge of a lesion and characterizes it, helping the physician to determine whether it is benign or malignant. |
Using American College of Radiology’s BI-RADS lexicon, B-CAD segments the edge of a lesion and characterizes it, assisting the physician in determining whether the lesion is probably benign or probably malignant. Then, it details all the information in a natural language report. “The quest is not to detect the lump; it has already been detected,” Sterritt said. “The quest is to be able to properly categorize the lump quickly ? and then document it well enough to be able to track changes.”
Advanced document management features include automated note taking and report generation of detailed findings for each lesion, easy editing and annotation of reports to match interpretations before printing and storing, and automatic population of patient information from a DICOM header in order to optimize accuracy and efficiency.
According to Cedara, the C4 platform delivers desktop integration of clinical applications to an established RIS/PACS solution. Through an application plug-in integration and development model, the development cycle is shortened, thus accelerating time to market and offering a streamlined best-of-breed clinical imaging solution.
Acting as an “invisible layer” between different software applications, C4 creates a means for bidirectional information to be exchanged between each unit. Furthermore, it uses a component-based architecture to generate a framework for host and plug-in applications to work together in unison and share system resources. As a result, C4 is designed to minimize the time and cost of integrating and maintaining the clinical application array that clinicians require.
When the two companies teamed up 3 years ago, Cedara—a Merge Healthcare company—and Medipattern each brought their specialized strengths to the table.
“The expertise at Medipattern is directed toward better identifying morphology in a breast,” Sterritt said. “We are specialists in pattern recognition and recognizing image content and its characteristics. Cedara’s Clinical Control Center is specialized in connectivity and integration. Through it, specialized companies like Medipattern can offer highly specialized technology to the broader market.”
While B-CAD has been on the market since 2005, its C4-enabled version is currently a work in progress.
Holding out for All-in-one Solution Works Wonders for Teleradiology Services Firm
Web access, scalability, and customer support were three key elements that Aris Teleradiology, Hudson, Ohio, considered during its search for a technology solution, and they were three qualities it found in RamSoft, a PACS solution provider headquartered in Canada.
Although the radiology services firm recognized that the software could become the backbone of the company, Aris opted to take things slow. In the end, holding back paid off.
“We made the decision during our implementation to hold off on installing the old RIS and instead wait for the release of the ?all-in-one’ RIS/PACS,” said Brian Knudtz, chief technology officer. “The advantages of having the RIS functionality that is truly integrated into the PACS and utilizes the same database made it worth the wait.”
Version 4.5 of RamSoft’s new PowerServer RIS/PACS recently made its debut as a comprehensive solution running on a single server and database. Among its features, the PowerServer is equipped with a Referring Physician Portal, simple patient registration capabilities, and a scheduling tool that is fully customizable. In this particular application, appointments can be resized during browsing, dragged between dates, and moved between resources. Demographic information is displayed on a single screen for quick verification; and insurance cards, prescriptions, and other documents may be scanned directly into the study.
As a single Web-based application, the software’s smart client eliminates the need to perform time-consuming tasks on numerous integrated systems with different interfaces. “Finding a vendor solution that was truly Web-based and allowed our clients and radiologist to access images and reports from any computer that had Internet access was an absolute requirement in our selection process,” Knudtz said.
Another factor in Aris’ decision to go with RamSoft was its scalability. Although it was a start-up company with initial volumes of just a few studies, Aris anticipated its work volume to increase by hundreds of thousands over the course of the next few years. “We needed a solution that would be able to grow with us,” Knudtz said. “Ramsoft’s design will allow us to grow and not require huge capital expenditures in the process.”
The new PowerServer fully supports both procedure and diagnosis coding, which are associated with scheduled appointments to simplify code management. A DICOM Modality Worklist ensures that patients are queued up after arrival and draws up a worklist in preparation for examination. As a result, there is no need for separate hardware to communicate between modalities and the RIS/PACS, according to RamSoft. Electronic forms, accessed using a keyboard and mouse or via PC tablet, can replace paper forms, which in turn reduces paperwork and printing costs. The technology can also post charges, demographics, and insurance information to most billing software solutions on the market.
Furthermore, the PowerServer software came with financial advantages. “The new design allowed us to save money by not requiring the purchase of additional servers for the RIS and guaranteed continuity in data by using the same database,” Knudtz said. “In Aris’ eyes, this new design is a huge market advantage of RamSoft.”
All in all, according to Knudtz, RamSoft not only delivered a quality product, but also “world-class service and support.” While design and technology are important, he continued, passion is something that must be present.
“My goal in selecting a RIS/PACS vendor was to partner with a company that would be just as passionate about my organization’s success as its own,” Knudtz said. “Ramsoft has not disappointed us in this area. Their staff have great customer service skills, superior technical knowledge, and interact with us as partners, not just another customer.”
